Doctors vs Patients vs Insurance Industry

On Sunday Matthias Muenzer of A Physician On Job Search and Practice made what I feel is a very important post regarding his opinion on physician income, the direction it is going and possible affects on the quality of care Americans will receive because of it. I found it enlightening and well written. The only thing I would take exception to is where he blames patients for physicians financial woes and glosses over the affects of the insurance industry. Bottom line, while costs (including insurance costs) are going up and in many places out pacing increases (if there are any) in gross income for physicians, patients are facing similar issues. For example, here at Professional Publishing, we've seen double digit increases in insurance premiums every year. At the same time, about every other year we're also seeing increases in copays and deductibles. Moreover, over the last 6 years, we've seen a decrease in the amount of services provided by our insurance carrier. We shop our coverage every year, too, and we've still got the best option avaialbe to us.

So, if physicians are working harder, paying more and earning less AND consumers are paying more and receiving less, then it follows that there is a huge cash windfall going to the insurance companies. Now I have no doubt that the insurance industry is affected by rising costs, too, but I also know that they are capitalist entities and exist mainly to make their stockholders and investors money.

While I'm no politician or expert on the economics and politics of the health care system, it seems pretty evident that the place to start addressing these issues is with the insurance industry.

I've attached Matthias' entire post (I hope he doesn't mind), because I think it's a valuable read. I strongly recommend A Physician On... as a regular read, as it's a very good source for information re: practicing medicine, especially when he shifts focus from his crusade against recruiters.

- WJ

Healthcare Heading towards Mediocrity

An anonymous comment on my blog: Doctors are working harder and harder to make a living and the cost of medical education is just about 60k per year. I believe declining medical school applications suggest that the word is out that medicine, while rewarding in many ways, is not a great way to make a living, much less pay off education related debt. In fact, the decline in physican incomes shows no signs of abating. Soon, a primary care physician in our area (Northeast US)will make less than 100K per year (many probably do already). When you consider that median family income in the US is about 50K, that is astounding. What effect will this have on future physician supply?

I agree, physicians early dramatically less than 20 years ago, and the incomes just keep dropping and dropping and dropping with no end in sight.

What message does this send to physicians? "We do not value what you do" or "We do not want you to earn much" "we do not care about your overhead" and "we do not care if and how you make ends meet"

This is what our patients are actually telling us physicians, yes, the same patients that demand to receive more attention, more time, more care, more presence, more sensitivity, more quality, more efficiency, more of everything. Actually medicine has been called "the worst business", because overhead increases, liability increases and you cannot pass on any of these increases to your clients and you get paid less and less!

The message Americans are sending physicians is "We do not care about you, just give as great service, now".

Where does this lead? We compensate, work more, harder, smarter, improve, improve more and then, when there is no more room for improvement, here comes "P4P", another thinky veiled slogan that allows HMOs to pay us less, the same old abuse, just with a different slogan, a different disguise.

I have a better idea for quality impovement: pay more, and physicians will be happy, proud and eager to work. This is obviously not going to happen. What will happen is what has happened in Germany, where I have seen the future of American healthcare: Lower pay to physicians lowers quality, lowered quality spawns more bureaucratic supervision, more hassle and indirectly less income, this again lowers quality and so on. In 15 years we will be in the realm of mediocrity in medicine. Money will be scarce, research will be superficial and less rewarding, clinical practice will be an 9-5 affair, and afterwards everybody goes to the ER. Your doctor does not see you when you are in the hospital, a hospitalist does. Training of physicians will be difficult, since it will be hard to get enough cases to gain sufficient experience, and training will be handicapped by the separation of office based and hospital based medicine. And everybody will complain and nobody will understand why.

Here is the explanation: You get what you pay for. And doctors are the crucial element in healthcare. We see the patients, we diagnose, we treat, we write the prescriptions, we decide.

Until Americans return to understanding that crucial point and return to taking care of those who care and decide over their health, we will continue on the path to mediocrity.

MEDIOCRITY. Continuing on the present path of decrasing pay and increasing bureaucratice hassle for physicians will lead straight to medicrity and over-administration - the two evil twins.

And that is exactly what the above quoted commentator thought. Pay physicians less and you chase them away. And why do we have a "primary care physician shortage" in Massachusetts? Easy to explain: Cost of living one of the highest in the US, housing cost one of the highest in the US, reimbursement one of the lowest in the US. Result: Physicians leaving the state. How stupid do expect doctors to be? Work for dramatically less than everywhere else in the US? There is a kind of silent agreement among doctors that you only stay in Masssachusetts if you work in academia (in this regard the state is a great place to be) or you have family that keeps you here.